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Gan Q, Edeiken BS, Chen MM, Grubbs EG, Busaidy NL, Zafereo M, Perrier ND, Gule-Monroe MD, Krishnamurthy S. Utility of subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance category in ultrasound-guided thyroid fine-needle aspiration in a large referral cancer center. J Am Soc Cytopathol 2019; 8:309-316. [PMID: 31526696 DOI: 10.1016/j.jasc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Subclassification of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is encouraged in the Bethesda System. In our practice, we subclassified AUS/FLUS into 3 subcategories: atypical follicular cells of undetermined significance (ACUS) for cases with cytologic atypia; follicular lesion (FL) for cellular cases with follicular cells with-minimal or no atypia, arranged in a macro- and micro-follicular pattern with scant colloid; and indeterminate follicular lesion, favor benign (IFL-FB) for cases with few clusters of follicular cells without atypia associated with minimal or no colloid. The objective of our study was to evaluate the prevalence, clinical management, and risk of malignancy for each subcategory. MATERIALS AND METHODS We retrospectively identified ultrasound-guided fine-needle aspiration (US-FNA) of thyroid cases that were subcategorized as ACUS, IFL-FB, and FL at our-institution during 2014-2016. The results of US-FNA were correlated with clinical outcome in the subsequent 2 years including repeat US-FNA, thyroid surgery, and clinical/imaging follow-up. RESULTS Of 3207 thyroid US-FNA cases, 718 (22.4%) cases were included in the study. Of these 718 cases, 104 (14.5%) were subcategorized as ACUS, 166 (23.1%) as FL, and 448 (62.4%) as IFL-FB. The surgery rate was 39.4% (41 of 104) for ACUS, 13.6% (61 of 448) for IFL-FB, and 27.1% (45 of 166) for FL. The risk of malignancy (ROM) was 25% (26 of 104) for ACUS, and 2.9% (13 of 448) for IFL-FB, 6.0% (10 of 166) for FL. The surgery rate and ROM was significantly higher for ACUS in comparison to IFL-FB (P < 0.05) and FL (P < 0.05). CONCLUSIONS Subclassification of AUS/FLUS into 3 groups based on cytopathologic findings alone not only improved the triage of patients for subsequent clinical management but also effectively stratified the risk of malignancy.
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Affiliation(s)
- Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth S Edeiken
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa M Chen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth G Grubbs
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Zafereo
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy D Perrier
- Department of Surgical Onclology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria D Gule-Monroe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Chinn SB, Zafereo ME, Waguespack SG, Edeiken BS, Roberts DB, Clayman GL. Long-Term Outcomes of Lateral Neck Dissection in Patients with Recurrent or Persistent Well-Differentiated Thyroid Cancer. Thyroid 2017; 27:1291-1299. [PMID: 28806882 DOI: 10.1089/thy.2017.0203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Well-differentiated thyroid carcinoma (WDTC) has a high predilection for regional metastatic spread. Rates for WDTC lateral neck recurrence are reported to be as high as 24% in patients after initial thyroidectomy, lateral neck surgery, and adjuvant radioactive (RAI) iodine treatment. The objective of the study was to evaluate the efficacy, safety, and long-term outcome of comprehensive lateral neck dissection (LND) of levels II-V for recurrent or persistent WDTC in a tertiary referral center. METHODS This study retrospectively analyzed the standardized approach of LND for recurrent WDTC in the lateral neck compartment. Survival was analyzed by Cox regression analysis. RESULTS Three hundred and seven patients underwent 429 LND for cytopathology-confirmed lateral neck recurrent WDTC at the University of Texas MD Anderson Cancer Center between 1994 and 2012. The vast majority (90%) of patients were originally treated elsewhere. Multilevel lateral neck dissection had been originally performed in 80% of patients, with 17% having undergone at least two previous operations. Two hundred and sixty-seven (87%) patients had previous RAI. The most common levels of recurrence were levels III and IV (33% and 33%, respectively). Postoperative complications were seen in 7% of patients. Median follow-up was 7.2 years. In-field lateral neck control was 96% at 10 years. Overall lateral neck regional control, overall survival (OS), and disease-specific survival (DSS) at 10 years was 88%, 78%, and 91%, respectively. When stratifying by age (<24 years, 24-50 years, and >50 years), OS and DSS was significantly better in patients <50 years (OS: p < 0.001; DSS: p < 0.001). However, there was worse overall lateral neck control in the younger group (<24 years; p = 0.04). Regional recurrence after salvage LND occurred within a median time interval of 20.0 months (2.9-121.3 months), of which 2% (8/429) developed in-field lateral neck recurrences. Of those with any lateral neck recurrence after salvage LND, 24/30 (80%) patients successfully underwent another LND, resulting in an ultimate 98% lateral neck regional control rate. CONCLUSIONS Expert comprehensive LND of levels II-V is associated with few perioperative complications and results in very high in-field regional control rate and ultimate lateral neck control in recurrent/persistent WDTC.
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Affiliation(s)
- Steven B Chinn
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Michigan , Ann Arbor, Michigan
| | - Mark E Zafereo
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Steven G Waguespack
- 3 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Beth S Edeiken
- 4 Department of Radiology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Dianna B Roberts
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Gary L Clayman
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
- 5 Clayman Thyroid Surgery and Thyroid Cancer Center, Thyroid and Parathyroid Institute , Tampa General Hospital, Tampa, Florida
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Clayman GL, Agarwal G, Edeiken BS, Waguespack SG, Roberts DB, Sherman SI. Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma. Thyroid 2011; 21:1309-16. [PMID: 22136266 PMCID: PMC3968954 DOI: 10.1089/thy.2011.0170] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Persistent or recurrent papillary thyroid carcinoma (PTC) occurs in some patients after initial thyroid surgery and often, radioactive iodine treatment. Here, we identify the efficacy, safety, and long-term outcome of our current surgical management paradigm for persistent/recurrent PTC in the central compartment in an interdisciplinary thyroid cancer clinical and research program at a tertiary thyroid cancer referral center. METHODS We retrospectively analyzed our standardized approach of comprehensive bilateral level VI/VII lymph node dissection (SND [VI, VII]) for cytologically confirmed PTC in the central compartment. RESULTS From 1994 to 2004, 210 patients, median age 42 (range 12-82) underwent SND (VI, VII). Most patients (106, 51%) had already undergone ≥2 surgical procedures for persistent or recurrent disease, and 31 (15%) had distant metastases at presentation. Postoperatively, 104 (71%) of the 146 patients who were thyroglobulin (Tg) positive had no evidence of disease. Anti-Tg antibodies were present in 38 patients (18%), 17 of whom (53%) did not have anti-Tg antibodies postoperatively. Fourteen patients (7%) were hypoparathyroid at presentation, and 2 more (1%) became permanently hypoparathyroid after surgery. Four patients (2%) experienced recurrent laryngeal nerve paralysis (RLNP) of a previously functioning nerve. Unanticipated RLNP was observed in only one nerve at risk. External beam radiation was given to 33 patients (17%). An additional 17 patients (8%) developed distant metastases during follow-up. At the last follow-up, 130 (66%) of the 196 patients had no detectable Tg; of these, 99 (76%) had no further evidence of disease. A median of 7.25 years after surgery, 167 (90%) of the 185 patients were without evidence of central disease, and 18 (10%) had developed central compartment recurrences within a median interval of 24.3 months. Of those with recurrence, 16 out of 18 patients (89%) underwent a subsequent surgical procedure, thus resulting in an overall 98% central compartment control rate. Kaplan-Meier disease-specific survival at 10 years was 98.9% for patients <45 years old and 77.9% for those ≥45 years old (log-rank p<0.00001). The only predictor of central compartment recurrence was malignancy in a thyroid remnant noted within the central compartment surgical specimen. CONCLUSIONS Bilateral comprehensive level VI/VII dissections are safe and effective for long-term control of recurrent/persistent PTC in the central lymphatic compartment.
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Affiliation(s)
- Gary L Clayman
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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Marshall CL, Lee JE, Xing Y, Perrier ND, Edeiken BS, Evans DB, Grubbs EG. Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery 2009; 146:1063-72. [PMID: 19958933 DOI: 10.1016/j.surg.2009.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 09/24/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pre-operative ultrasonography (US) is now part of published treatment guidelines for papillary thyroid carcinoma (PTC), despite the lack of long-term data on its potential value in preventing neck recurrence. We report the follow-up of patients with PTC in whom pre-operative US was used to accurately stage the extent of neck disease. METHODS Patients with PTC who underwent pre-operative US and surgery were evaluated by indication for surgery (primary surgery, surgery for persistent PTC, and surgery for recurrent PTC). Patients who underwent their primary surgery at our institution were further evaluated by time period in which their pre-operative US was performed. Primary outcome studied was cervical recurrence. RESULTS A total of 275 patients underwent pre-operative US; median follow-up was 41 months. Neck recurrence occurred in 6% of primary surgery patients, 5% of persistent-disease patients, and 23% of recurrent-disease patients (P < .001). By multivariate analysis, the era in which US was performed appeared to be an independent predictor of disease-free survival, with less cervical recurrences in the recent eras during which there was more US specialization. CONCLUSION Once a patient with PTC experiences neck recurrence, they are at an increased risk for subsequent neck recurrence. Pre-operative US followed by compartment-oriented surgery may decrease recurrence rates in patients if performed before their primary operation.
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Affiliation(s)
- Christy L Marshall
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Clayman GL, Shellenberger TD, Ginsberg LE, Edeiken BS, El-Naggar AK, Sellin RV, Waguespack SG, Roberts DB, Mishra A, Sherman SI. Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck 2009; 31:1152-63. [PMID: 19360746 DOI: 10.1002/hed.21079] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the generally favorable prognosis of patients with papillary thyroid cancers, 10-year recurrence rates for patients with stage I to III disease is greater than 20%, with central compartment recurrences common among these recurrent sites. METHODS This study is a retrospective analysis of consecutive patients treated by a single surgeon over an 18-month period of time terminating in 2003. RESULTS Sixty-three patients underwent a comprehensive dissection of levels VI and VII for papillary thyroid carcinoma during this period. There was a female predominance of 2:1, with 48% of patients being greater than 45 years of age. The median number of lymph nodes identified was 16 (range, 3-52), with 7 (1-20) lymph nodes pathologically involved. Permanent hypoparathyroidism was present on presentation in 13% of patients and developed in an additional 5% following surgery. Although recurrent laryngeal paralysis was present on presentation among 8 (13%) of patients, no patients experienced paralysis of documented functioning recurrent laryngeal nerves or necessitated tracheotomy. Postoperative thyroglobulin levels were reduced to nondetectable in 71% of the informative cases. Over 60% of patients were discharged on their first postoperative day. CONCLUSION Bilateral paratracheal and superior mediastinal dissection is an oncologically safe procedure exhibiting minimal morbidity when performed among experienced individuals despite multiple prior surgical procedures or existing vocal cord paralysis.
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Affiliation(s)
- Gary L Clayman
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Mortenson MM, Evans DB, Lee JE, Hunter GJ, Shellingerhout D, Vu T, Edeiken BS, Feng L, Perrier ND. Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography. J Am Coll Surg 2008; 206:888-95; discussion 895-6. [PMID: 18471717 DOI: 10.1016/j.jamcollsurg.2007.12.044] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Accepted: 12/01/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reoperation for hyperparathyroidism (HPT) carries an increased risk for morbidity and failure to cure. Accurate preoperative localization minimizes operative risk but is often difficult to achieve in the reoperative setting. Four-dimensional computed tomography (4D-CT) is an emerging technique that uses functional parathyroid anatomy for precise preoperative localization. We evaluated 4D-CT as a tool for localization of hyperfunctioning parathyroid tissue in the reoperative setting. STUDY DESIGN A prospective endocrine database was queried to identify 45 patients who underwent reoperative parathyroidectomy after preoperative localization using 4D-CT. The patients were categorized into 1 of 3 groups: group 1 included those who had previous neck surgery for non-HPT conditions; group 2 included those who had undergone a previously unsuccessful neck exploration for HPT; and group 3 included patients with HPT who had a previous neck exploration with resection of at least 1 hypercellular parathyroid. RESULTS The sensitivity of 4D-CT for localization was 88% compared with 54% for sestamibi imaging. Four-dimensional CT more often correctly localized (p=0.0003) and lateralized (p=0.005) hyperfunctional parathyroid tissue than sestamibi did. Four-dimensional CT successfully localized hyperfunctional parathyroid tissue in 18 (82%) of 22 group 1 patients, 10 (91%) of 11 group 2 patients, and 8 (67%) of 12 group 3 patients. Three patients were lost to followup. At a mean followup of 9.8 months, 39 (93%) of 42 patients were surgically cured and 3 patients (7%; 2 in group 3) had persistent HPT. CONCLUSIONS Four-dimensional-CT is an ideal tool for preoperative localization of hyperfunctioning parathyroid tissue in the reoperative setting. Localization and successful reoperation are most difficult in patients who have undergone an earlier operation that included resection of at least one hypercellular parathyroid suggesting multigland disease.
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Affiliation(s)
- Melinda M Mortenson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Mittendorf EA, Wang X, Perrier ND, Francis AM, Edeiken BS, Shapiro SE, Lee JE, Evans DB. Followup of Patients with Papillary Thyroid Cancer: In Search of the Optimal Algorithm. J Am Coll Surg 2007; 205:239-47. [PMID: 17660070 DOI: 10.1016/j.jamcollsurg.2007.02.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 02/28/2007] [Accepted: 02/28/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervical recurrence occurs in up to 30% of patients after surgical treatment for papillary thyroid cancer. This study sought to determine an appropriate algorithm for followup evaluation. STUDY DESIGN Patients undergoing total thyroidectomy for papillary thyroid cancer were identified. Clinicopathologic data were recorded, as were the results of all followup evaluations including radioiodine scan, cervical ultrasonography, and serum thyroglobulin levels. The disease recurrence-free survival probability was estimated, and risk factors for recurrence were determined. RESULTS Thyroidectomy with or without neck dissection was performed in 162 patients. We excluded 36 patients (followup less than 6 months in 26, extracervical disease at diagnosis in 4, unknown tumor size in 6) from the analysis. Of the remaining 126 patients, 109 (86.5%) had no evidence of disease, with serum thyroglobulin < 1 ng/mL at last followup; 4 (3.2%) had no evidence of disease (negative imaging), with serum thyroglobulin > 1 ng/mL, and 13 (10.3%) had recurrent disease. Cervical recurrence occurred in nine patients, all detected by routine ultrasonography. Pulmonary metastases occurred in four patients; three were diagnosed by chest CT and one by radioiodine scan. Thyroid stimulating hormone-suppressed thyroglobulin levels were available in 11 of the 13 patients and were elevated in 9. Patients with high T stage (extrathyroidal extension), or high N stage had an increased risk of recurrence. CONCLUSIONS A followup strategy emphasizing routine cervical ultrasonography and unstimulated thyroglobulin is effective in identifying patients with recurrent papillary thyroid cancer, and may minimize the indiscriminate use of therapeutic radioiodine for radiographically occult disease. Surgery remains the optimal treatment of cervical recurrence, which is the dominant pattern of treatment failure.
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Affiliation(s)
- Elizabeth A Mittendorf
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD, Shapiro SE, Edeiken BS, Truong MT, Evans DB, Lee JE, Perrier ND. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 2006; 140:932-40; discussion 940-1. [PMID: 17188140 DOI: 10.1016/j.surg.2006.07.028] [Citation(s) in RCA: 265] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 07/26/2006] [Indexed: 12/24/2022]
Abstract
BACKGROUND Four-dimensional computed tomography (4D-CT) provides both functional and highly detailed anatomic information about parathyroid tumors. The purpose of this study was to compare 4D-CT with sestamibi imaging and ultrasonography as methods for the accurate preoperative localization of hyperfunctioning parathyroid glands before parathyroidectomy. METHODS A study of 75 patients with primary hyperparathyroidism was performed at a tertiary-care institution. Sestamibi imaging, ultrasonography, and 4D-CT were performed on each patient preoperatively. Results of the imaging studies were compared with operative findings, pathologic data, and biochemical measurements to assess the sensitivity and specificity of each of the imaging modalities. RESULTS 4D-CT demonstrated improved sensitivity (88%) over sestamibi imaging (65%) and ultrasonography (57%), when the imaging studies were used to localize (lateralize) hyperfunctioning parathyroid glands to 1 side of the neck. Moreover, when used to localize parathyroid tumors to the correct quadrant of the neck (ie, right inferior, right superior, left inferior, or left superior), the sensitivity of 4D-CT (70%) was significantly higher than sestamibi imaging (33%) and ultrasonography (29%). CONCLUSION 4D-CT provides significantly greater sensitivity than sestamibi imaging and ultrasonography for precise (quadrant) localization of hyperfunctioning parathyroid glands. This allows improved preoperative planning, particularly for the case of reoperation. In addition to the data that are provided, we present a novel classification scheme for use in parathyroid localization.
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Affiliation(s)
- Steven E Rodgers
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Fornage BD, Sneige N, Ross MI, Mirza AN, Kuerer HM, Edeiken BS, Ames FC, Newman LA, Babiera GV, Singletary SE. Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study. Radiology 2004; 231:215-24. [PMID: 14990810 DOI: 10.1148/radiol.2311030651] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the feasibility and safety of ultrasonographically (US) guided percutaneous radiofrequency (RF) ablation in the local treatment of invasive breast carcinomas 2 cm or less in greatest diameter. MATERIALS AND METHODS RF ablation of 21 malignant lesions was performed in 20 patients immediately before their scheduled lumpectomy or mastectomy. A 15-gauge needle electrode was placed in the lesions, and the prongs of the needle electrode were deployed with real-time US guidance. A temperature of approximately 95 degrees C was maintained for 15 minutes at the tips of the prongs. Histopathologic examination of the resected specimens included use of nicotinamide adenine dinucleotide in its reduced form-diaphorase stain, which is specifically used to confirm thermal cell injury and lack of viability. The desired outcome of the procedure was ablation of the tumor and of an adequate margin around it, as confirmed by the absence of viable tissue in the surgical specimen. RESULTS In all 21 cases, complete ablation of the target lesion was visualized at US. In one patient, who had undergone preoperative chemotherapy for a mass that was initially judged to be a T2 tumor but who was found to have a small residual tumor at mammography and US performed at the time of ablation, the target lesion was ablated but residual in situ mammographically and US occult invasive carcinoma was found at histopathologic examination. There were no adverse effects. CONCLUSION US-guided percutaneous ablation of small invasive breast carcinomas is feasible and safe.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Catheter Ablation
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Prospective Studies
- Severity of Illness Index
- Treatment Outcome
- Ultrasonography, Mammary
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Affiliation(s)
- Bruno D Fornage
- Dept of Diagnostic Radiology, Univ of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Edeiken BS, Fornage BD, Bedi DG, Sneige N, Parulekar SG, Pleasure J. Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Radiology 2003; 227:542-8. [PMID: 12732703 DOI: 10.1148/radiol.2272011175] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the value of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in the detection and diagnosis of recurrent cancer in breasts reconstructed with autogenous myocutaneous flaps after mastectomy for primary breast cancer and to describe the US appearances of recurrence in the reconstructed breast. MATERIALS AND METHODS Between July 1994 and March 2001, US of the reconstructed breast was performed in 20 women with autogenous myocutaneous flap reconstruction. US findings were correlated with clinical and mammographic findings. US-guided FNAB of 25 (64%) of the 39 recurrent cancers depicted at US was performed. RESULTS Twenty-one (54%) of the 39 recurrent cancers depicted at US were clinically occult. Mammography performed in 12 of the 20 patients with reconstructed breasts depicted 14 (56%) of the 25 recurrent cancers that were detected at US in these patients. US-guided FNAB helped to establish a definitive diagnosis of recurrent breast carcinoma in 24 (96%) of the 25 tumor specimens sampled. CONCLUSION US and US-guided FNAB are valuable for the assessment of both palpable and clinically occult recurrent breast cancers in autogenous myocutaneous flap breast reconstructions.
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Affiliation(s)
- Beth S Edeiken
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston 77030, USA.
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Abstract
This review article covers the basic applications of and latest developments in interventional breast sonography (US). For breast masses, US has become the standard for guiding needle biopsy, whether a fine needle or a core biopsy needle is used. US has also become the preferred method for guiding insertion of various localization devices for nonpalpable masses, and US's intraoperative use for this purpose is expanding. Recently, US has been used to monitor the placement of percutaneous ablation devices, such as radiofrequency ablation needle-electrodes, into breast masses, including carcinomas. US is not indicated for the routine evaluation of microcalcifications. However, on occasion, clusters of microcalcifications without a mass can be visualized on sonograms with sufficient clarity to undertake a US-guided core biopsy if stereotactically guided biopsy cannot be performed for technical reasons.
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Affiliation(s)
- Bruno D Fornage
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Box 57, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Edeiken BS, Fornage BD, Bedi DG, Singletary SE, Ibrahim NK, Strom EA, Holmes F. US-guided implantation of metallic markers for permanent localization of the tumor bed in patients with breast cancer who undergo preoperative chemotherapy. Radiology 1999; 213:895-900. [PMID: 10580972 DOI: 10.1148/radiology.213.3.r99dc34895] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metallic markers were implanted with ultrasonographic guidance in 51 malignant breast tumors in 49 patients to tag the tumor bed in anticipation of complete or almost complete response to preoperative neoadjuvant induction chemotherapy before breast-conservation surgery. The markers were the only remaining evidence of the original tumor site in 47% (23 of 49) of the patients preoperatively. This technique effectively addresses the problem of preoperative localization of the tumor bed in complete or nearly complete response of breast cancer to neoadjuvant chemotherapy.
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MESH Headings
- Adult
- Aged
- Biopsy, Needle/instrumentation
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoadjuvant Therapy
- Prostheses and Implants
- Stainless Steel
- Ultrasonography, Mammary
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Affiliation(s)
- B S Edeiken
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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Abstract
The purpose of this report is to describe giant solitary synovial chondromatosis, a previously unrecognized feature of synovial chondromatosis that may histologically and radiographically mimic a malignant neoplasm. Giant solitary synovial chondroma is an intra- and/or extraarticular lesion measuring over 1 cm in size and sometimes as large as 20 cm. The radiographic appearance is that of a large, well-marginated mass either of irregular feathery calcification from coalescence of multiple small synovial chondromas, or a rounded calcified mass from the growth of a single synovial chondroma. Radiographically, giant solitary synovial chondromatosis may appear similar to chondrosarcoma and parosteal osteosarcoma.
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Affiliation(s)
- J Edeiken
- Department of Diagnostic Radiology, University of Texas, M.D. Anderson Cancer Center, Houston 77030
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14
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Abstract
OBJECTIVES We describe a 1-year remedial program for radiology residents with deficiencies in basic medical sciences that cause difficulty in the understanding and application of basic radiologic principles. METHODS Six of 107 residents participated in the remedial program at separate times during an 8-year period. The design of the remedial program was based on the following: 1) reassignment to first year basic radiology rotations with 1-year delayed advancement to the subspecialty rotations; 2) comprehensive radiology texts that contain a detailed review of related embryology, anatomy, physiology and pathology; 3) instruction in the study of the texts; and 4) repetitive learning accomplished by intermittent reassignment of rotations in which difficulty was demonstrated. Resident performance was evaluated by correlation of monthly written faculty evaluations, the results of the American College of Radiology Intraining Examination, and the American Board of Radiology (ABR) written and oral examinations. RESULTS During the period of remediation, faculty evaluation revealed improved performance in all six residents from below-average ratings (mean = 2.3) to above-average and superior ratings (mean = 8.3). These results were correlated with the American College of Radiology Intraining Examination scores, which improved from the lowest quartile (range 0% to 28%) to the highest (range 78% to 99%). Each resident successfully passed the ABR written and oral boards on the first attempt. Two additional residents who were offered but did not accept remediation eventually dropped out of the program or repeatedly failed the written ABR examination. CONCLUSIONS Ultimately, strengthening basic medical science knowledge facilitated interpretation of radiographs by enabling the integration of basic radiologic and scientific principles and understanding the underlying basic medical, radiologic, and clinical significance.
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Affiliation(s)
- B S Edeiken
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston
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15
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Ferris EJ, Harmon BH, Tonkin IL, Becker GJ, Edeiken BS, Pfister RG, Osborn AG. Image interpretation session. The Radiological society of North America 74th scientific assembly and annual meeting. November 27, 1988. Proceedings. Radiographics 1989; 9:85-114. [PMID: 2913620 DOI: 10.1148/radiographics.9.1.2913620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- E J Ferris
- University of Arkansas for Medical Sciences, Little Rock 72205
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16
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Abstract
Seven cases of osteosarcoma in their very early stage of development are presented. With the exception of two cases the tumors were overlooked in the first radiographic examination. Two cases demonstrated increased density, three revealed subtle erosion or lytic destruction, and one case had no definite abnormality in plain radiographs but the computed tomography was abnormal. The value of additional radiographic modalities is outlined. The necessity of a high degree of suspicion for early diagnosis of osteosarcoma is stressed.
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17
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Abstract
Slipped proximal humeral epiphyses as a sequela of radiotherapy were identified in two children treated for Ewing's sarcoma in whom the shoulder was included in the field of treatment. The radiation doses were slightly greater than those in children developing slipped capital femoral epiphyses following radiotherapy. The lesser stress about the shoulder compared to the hip is believed to be the reason this is an infrequent complication of radiotherapy.
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19
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Abstract
Significant radiation-induced abnormalities (aseptic necrosis of the femoral heads, slipped capital femoral epiphysis, radiation-induced sarcoma) were identified in eight of 44 patients aged 16 years or younger at the time of radiotherapy and followed for at least 3 years. The incidence is 18% in the entire group and 25% (8/32) if only patients with radiographs of the hips 3 or more years after therapy are considered. The first evidence of abnormality developed 13 years after irradiation in one patient. The need for long term follow-up of therapeutically irradiated children is stressed.
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